Provider Demographics
NPI:1902514359
Name:JONES-HIGGINBOTTOM, DANIELLE ANNETTE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANNETTE
Last Name:JONES-HIGGINBOTTOM
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S GLENBURNIE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2610
Mailing Address - Country:US
Mailing Address - Phone:252-336-3646
Mailing Address - Fax:252-421-9200
Practice Address - Street 1:1425 S GLENBURNIE RD STE 2
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-336-3646
Practice Address - Fax:252-421-9200
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0184591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX43910627OtherDRIVERS LICENSE